Problems, promise of Affordable Care Act aired at conference

Nov. 8, 2013

Gannett Wisconsin Media

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Press-Gazette Media

MENASHA — Even proponents of the Affordable Care Act are doubtful the signature online marketplace will be fixed by Nov. 30, as federal officials have promised. But their belief in the good the law can do — eventually — is undiminished.

“I think we have a remarkable opportunity to improve the lives of many of our fellow citizens in Wisconsin,” said Bobby Peterson, executive director and public interest attorney for ABC for Health Inc.

More of the discussion Friday at the Wisconsin Institute for Public Policy and Service conference centered on problems and uncertainties involved in the launch of the Affordable Care Act, also known as Obamacare. The conference, titled “It’s Here: The Federal Health Insurance Marketplace in Wisconsin,” was held at the University of Wisconsin-Fox Valley. About 180 people registered for the event.

Kevin Hayden, CEO of Group Health Cooperative, Madison, said he is skeptical the online marketplace, where people must sign up for insurance to get subsidized premiums, will be fixed by the end of the month. The enrollment feature of healthcare.gov, beset with problems since its launch on Oct. 1, has been a major embarrassment to the Obama administration and a frustrating obstacle to most people trying to get insurance.

“Even supporters believe the marketplace should not have opened Oct. 1. It was done for political reasons. No one’s hands are clean,” said Steven Brenton, president and CEO of the Wisconsin Hospital Association. “I also am not holding my breath for Nov. 30.”

Underlying all discussion about health insurance reform was an understanding that health care reform is the only means to actually reduce costs.

“Until we address system costs, it’s not going to change,” said Joel Lingenhag, director of commercial business strategy for Network Health Plan, Menasha.

According to one study, the United States pays double for health care services of other developed countries, but ranked 39th in the world in value of care, said Joseph Harris, assistant professor of sociology at Boston University.

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Numerous speakers pointed to the inefficiency in the American health care system and the need to pay less and get better health outcomes. Part of that problem is there is no true competition in the U.S. system, said Merton Finkler, chairman of the economic department and Robert Wood Johnson Fellow in Health Care Finance at Lawrence University, Appleton.

“Americans have an instinctive distrust of government and faith in the private market, but are unwilling to accept the harsh verdict of private markets,” Finkler said.

The model for the Affordable Care Act was Massachusetts, which enacted reforms in 2006. Jonathon Gruber of MIT, an architect of the law, said Massachusetts reform relied on three principles: an end to discrimination based on sickness, a requirement that everyone buy insurance and subsidies. Gruber said the law forced premiums down, but did not reduce health care costs, which rose at the same rate as the national average. Gruber said that was because the Massachusetts reform did not go far enough.

“Obamacare is designed to (take on health care costs),” he said.

Molly Brandt, director of the Covering Kids and Families organization, expressed irritation at the amount of attention given to the failed enrollment process.

“ACA is 10 titles,” said “Only two of them, in fact, address health insurance reform, though we spend all of our time discussing health insurance reform.”

Participants in the event tried to avoid the politics of reform, but that’s like going swimming and trying to avoid the water. Gruber did a cannonball dive when the subject of Medicaid expansion came up.

Wisconsin Gov. Scott Walker rejected federal funding to expand Medicaid in the state. He chose instead to enact state reforms that included moving 77,000 people from BadgerCare, the state Medicaid plan, to Affordable Care Act plans, making room for others to come off a BadgerCare waiting list. That decision is now complicated by the dysfunctional federal marketplace.

“It is nothing less than political malpractice that these states aren’t expanding Medicaid,” said Gruber, calling the decision horrible.

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That earned a rebuke later in the day from Hospital Association CEO Brenton.

“We need to knock off finger pointing and sarcasm,” Brenton said. “It was unfortunate it came up this morning from someone outside of Wisconsin.”

Greg Nycz, executive director of Family Health Center of Marshfield, said Affordable Care Act design has glaring holes in rural areas; in some counties plans upon which subsidies are based will not be available, causing poor people to pay more than the act anticipated.

“You can’t compare the Affordable Care Act to perfection. You have to compare it to what we have today. The Affordable Care Act is better than what we have today,” Gruber said. “They have to recognize they are getting something. They were getting nothing before. We have to continue to work (on it).”

Nycz wasn’t mollified.

“People making $12,000 a year in Oneida County can’t wait,” he said.

Brenton and insurance company executives said they are most concerned about the first year of the ACA because of the likelihood that mostly the sickest people will sign up for insurance. The reform relies on getting healthy young people to buy insurance to pay for unhealthy enrollees. Too many new, unhealthy customers could cause financial problems for some insurance providers who stepped up to be a part of the reform.

People who don’t buy insurance can be penalized, about $95 during the first year, which Timothy Byrne, vice president and partner in M3 Insurance, Green Bay, called a joke. “There has to be a disincentive to not take insurance,” he said.

Brenton predicted enrollments on the exchange would be “excruciatingly slow, in the tens of thousands, not hundreds of thousands.”

At the end of the day, no one knows what’s going to happen, said J.P. Wieske, spokesman for the state department of insurance.

“What the world looks like right now is not what the world is going to look like a year from now, or after that,” he said.